NCG060209 DMR SW (11)

CERTIFICATE OF
FACILITY NAME
COUNTY
PERSON COLLEC
LABORATORY
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of WateruallV17 Gl Permit No. NCG060001
Date submitted
NO.P PG06a&q
SAMPLES
Lab Cert. #
Part Ai Stormwater Benchmarks and Monitorina Results
'CIV®
SAMPLE COLLECTION YEAR
a1) s hF� 'qZUIZI
FACILITY ACTIVITIES INCLUDE (che5c all that apply):N��1��?Illl�,TV
❑ use/process meats use animal fas/byproduct�1i i tp"t,�'
DISCHARGING TO SALTWATERS? [ YES 0260
PLEASEREMEMBER TO SIGN ON THE REVERSE 4
Tntnl pvpnt rnlnfnll 2 nr TjA!n r/fcAnrnv thic narlAW
;! gju wm"1q i sry.i`t
°
K �1�
=. nl •11 %l il'(95���'His'!��Y� I1. 1 � � i
f '!l�diJdl�
i' t
L�lIa
1.�.l'�
' �' ��.:v c `" s- = _° El
�j f7jypmr
a Its ��{{�b!>U p�yEi ��{i_
3% b��' ,:1:�f3•' L'�•�1}-,:Eli_ D i
-0
� � T +'i Il . 1• �i',• � n.•• �•0� � Z I h Tai}"
Y r� 7 t 1 • 1^ t' do f�Yi S�R�
�J D 1 i_ y .i1�lYi�6�D�'FNi��
—y L—LWWW53-Meals.
ZThe total precipitation must be recorded using data from an on-site rain gauge. "�iJ FLO
aFor sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
See General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor all per month? ❑ yes ❑ no (ff yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Reculte• nnlu fnr &AIltiee a..erseb.n -4�. ee seal mf MA\./ s"ma-~ MI I. mvs&16
_—
F
_ I � -
'iltrrp i-ny� '
e-,
E;� �i .,p £ r lEr3E�l'Id9��95t1hq
� iR eL�� 49� - �
_
`
I.r "r t �'.4�jr,>�L;Res��._
,� l . - 1 �3�'`li 444 � i 4r 1�1 ` urr''cl ��;��-ta:0:f1`h-L•Lc��tYu�c•! � �'j !l�F ��i
v111y nFlNuas Lu MGp1pC5 Alai use/prOCeSS meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge.
aFor sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWM -249
T.fICF RPvfCP-A• (lrtnhr:r 1 Si_ 9012

*FOR PART A AND PART B MONITORING RESULTS:
® A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 S TION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES TNO ❑
IF YES, HAVE YOU CONTACTED THE DIr R GIO A OF ICE? 1_E NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainai and one cony of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab -results for at end of
monitoring period in the case of "No Discharge" reoortsl to:
Division of Water Quality
Attn: DWQ Central Files
161dCMail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the Information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of
tal-jo i S
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wa/ws/su/npdessw#tab-4
SWU-249
�1.
Last Revised: October 18, 2012
Page 2. of 2 ay